The socioeconomic impact of a femoral neck fracture on patients aged 18-50: A population-based study

BackgroundBy linking health and census data, the objective of this study was to determine the effect of a femoral neck fracture on the household income of non-elderly patients.MethodsAll individuals aged 18–50 who underwent internal fixation for a femoral neck fracture during the years 2006–2012 in the Canadian Province of British Columbia were included in the study. Patient-level hospital data was linked with patient’s after-tax household income decile, as estimated by Statistics Canada Postal Code Conversion Files. The primary endpoint was a decline of ≥2 income deciles following the index fracture. Kaplan-Meier analysis was performed to estimate the probability of income decline during the study period. A Cox regression model was used to study the association between a ≥2 income decline and patient age, sex, reoperation, and pre-injury income decile.ResultsOf the 391 femoral neck fracture patients included, the majority of patients were male (61.6%), with a median age of 43 years (IQR: 35–48), and a pre-injury median income in the fifth decile (IQR: decile 3–8). 27.0% of patients sustained a decline of ≥2 income deciles during the study period, with 16.3% declining ≥2 income deciles within 2-years of injury. A pre-injury household income in the top 4 deciles (mean of deciles: $57,000–170,500) was associated with an increased likelihood of a ≥2 drop in household income (HR: 1.38, 95% CI: 1.06–1.79, p = 0.02).DiscussionOver a quarter of the femoral neck fracture patients in this study sustained a decline of ≥2 deciles in their household income following their injury. The income decline was disproportionately absorbed by patients with baseline incomes in the 6^th decile or higher. This suggests that the available incapacity programs are limited in providing income protection to patients with higher incomes.     

Prospective associations of breastfeeding and smoking cessation among low‐income pregnant women

Although low‐income pregnant women have high rates of smoking and low rates of breastfeeding, few studies have examined prospective associations between these risk factors in community samples. Doing so may help improve breast‐feeding support programs in this population. We used a secondary analysis of 247 low‐income pregnant smokers in Memphis, Tennessee, who were interviewed up to 4 times (twice during pregnancy and twice through 6 months postpartum). Smoking cessation during prepartum and postpartum was defined as a self‐report of not smoking for ≥1 week and an expired carbon monoxide level of <10 ppm. Multivariable logistic regression analyses were used to determine whether intent to breastfeed was associated with smoking cessation and whether smoking cessation was associated with actual breastfeeding. Models were adjusted for sociodemographic, pregnancy‐related, and smoking‐related confounders. Thirty‐nine percent of participants intended to breastfeed, and 38% did so. Women who intended to breastfeed were 2 times more likely to quit smoking prepartum (adjusted OR = 1.99, 95% CI [1.06, 3.74]), but not postpartum (adjusted OR = 1.27, 95% CI [0.57, 2.84]). Quitting smoking at baseline and during pregnancy was associated with subsequent breastfeeding (adjusted OR 2.27, 95% CI [1.05, 4.94] and adjusted OR = 2.49, 95% CI [1.21, 5.11]). Low‐income women who intended to breastfeed were more likely to quit smoking during pregnancy and those who quit smoking at baseline and prepartum were more likely to breastfeed. Simultaneously supporting breastfeeding and smoking cessation may be very useful to change these important health behaviours among this high‐risk population.     

云南省个旧市急性腹泻的影响因素分析

摘要:目的　了解个旧市急性腹泻的影响因素,为科学制定防制措施提供依据和支持。方法　采用病例-对照研究的方法,自行设计量表收集个旧市8家医疗机构一年内的初诊急性腹泻病例和同样数量的医院内对照的基本情况、暴露史、卫生习惯等信息。数据采用单因素卡方和多因素Logistic 回归进行分析。结果　个旧市急性腹泻的主要临床表现,如大便性状、腹痛、呕吐、发热等,提示以感染性腹泻为主。多因素Logistic回归分析显示,家庭人均年收入（OR＝0.819,P＝0.001）、饭前便后洗手（OR＝0.572,P＝0.001）、经常与别人共用餐具（OR＝2.163,P＝0.010）、经常外出就餐（OR＝2.471,P＝0.008）、发病3 d内外出就餐（OR＝2.566,P＝0.006）和接触腹泻患者（OR＝1.152,P＝0.039）为急性腹泻感染的影响因素。结论　个旧市急性腹泻以夏季高发;影响因素有家庭人均年收入、饭前便后洗手习惯、经常与别人共用餐具、经常外出就餐、发病3 d内外出就餐和接触腹泻患者等,防制措施包括开展居民卫生习惯的健康教育、帮助低收入家庭改善卫生条件、加强餐饮行业的食品安全监管等。     

关于完善医院经济管理和职工收入分配改革方案的探讨

财政部、卫生部颁布和印发的《医院财务制度》、《医院会计制度》对药品分开核算，分别管理、固定资产分类核算、采用折旧方法计提修购基金、医疗药品成本核算、结余分配模式等诸多医院经济管理内容提出了新的要求和规范。文章就医院在医疗机构改革、医疗保险改革、执行新的医院财会制度框架下，如何进一步推进改革进程，继续搞好职工收入分配，提高经济管理水平的问题，提出探讨性意见。     

乡村医生收入状况调查方法探讨

目的：比较分析获取乡村医生收入状况的不同途径，寻求能够客观描述其收入状况的方式。方法：通过现场观察和访谈，获得乡村医生处方行为、村卫生室门诊工作量及村医收入自评情况等资料。结果：不同途径所得的村医收入存在较大差异，根据门诊量并结合抽样处方费用得到的收入最为可靠；被调查的乡村医生的从医报酬为3000元／月左右。结论：在实际研究中，可采取多种途径测算村医收入，根据村卫生室门诊工作量和药品购进量测算较访谈和报表资料能更真实地反应收入状况。     

Socioeconomic Status, Marital Status and Hip Fracture Risk: A Population-Based Case–Control Study

Socioeconomic status and social support have been identified as important determinants of several diseases and overall mortality, but these factors have not been adequately examined in relation to hip fracture risk. The aim of this study was to determine the relationship of socioeconomic status and marital status to hip fracture risk. We used data from a population-based case–control study in postmenopausal women aged 50–81 years during 1993–1995 who resided in six counties in Sweden. The analysis was based on 1327 incident cases of hip fracture and 3262 randomly selected controls. Socioeconomic and marital status were obtained by record linkage with census data in 1960, 1970, 1980 and 1990. Information on other possible risk factors for hip fracture was collected by a mailed questionnaire. Women who were gainfully employed in 1990 had an odds ratio (OR) of 0.74 [95% confidence interval (CI) 0.56–0.96] compared with those not gainfully employed; those in the highest tertile of household income had an OR of 0.74 (95% CI 0.60–0.90) compared with those in the lowest tertile of income. Women who lived in a one-family house had an OR of 0.85 (95% CI 0.72–0.99) compared with those living in an apartment. Divorced, widowed or unmarried women had a higher risk of hip fracture than married or cohabiting women; the OR was 1.40 (95% CI 1.06–1.85). Married women who were both gainfully employed and were living in a one-family house had a substantially decreased risk of hip fracture compared with unemployed women living without a partner in an apartment (OR 0.39; 95% CI 0.22–0.71). Occupational affiliation among women ever employed, and educational level, were not associated with hip fracture risk. We conclude that employment, household income, type of housing and marital status seem to be risk indicators of hip fracture risk independent of known osteoporotic risk factors. Received: 6 October 1999 / Accepted: 29 March 2000     

Relative deprivation and mortality in South Africa

This paper tests the relative income hypothesis by considering the relationship between mortality, income and relative deprivation in South Africa using individual-level data on income and five measures of relative deprivation each with a different reference group. We find that income tends to be protective of, and relative deprivation detrimental to health, but the latter often gives a better account of mortality than does income alone. For some population groups the fit is improved in specifications which include both income and relative deprivation. Overall, there seems to be solid evidence in support of the relative income hypothesis, particularly for the more economically disadvantaged population groups. Relative deprivation is especially significant when age is the reference group, suggesting that the comparison of socio-economic standing that has an impact on health tends to happen within cohorts. The results are robust to splitting the sample into urban/rural subsamples and to looking at the incidence of illness as the health outcome rather than mortality. While little is known about the mechanisms underlying the effect of relative deprivation on health and mortality, the consistent evidence in favor of age as a reference group, particularly in a context like South Africa's suggests that intra-cohort comparisons should be an avenue for more in depth investigation.     

玉环县4367例已婚妇女常见病普查及分析

目的了解本地区已婚妇女常见病的发病情况,促进妇女生殖健康水平。方法对本地区已婚妇女普查,观察发病情况及与年龄、文化水平、经济水平的关系。结果 4367例已婚妇女中检出常见病2401例,发病率为54.98%;以宫颈疾病和阴道疾病为主,分别检出957例和879例,发病率分别为21.91%和20.13%;患病率最高的两个年龄段为30～39岁及20～29岁,发病率分别为67.47%和59.43%,40岁以上患病率随年龄增长呈下降趋势;小学及以下文化水平妇女患病率最高,为66.14%,初中、高中以上文化水平患病率分别为54.03%和44.32%;家庭月收入〈2000元的已婚妇女发病率最高,为69.81%,家庭收入在2000～4999元的患病率为55.35%,家庭收入≥5000元的妇女患病率最低,为40.91%。结论玉环县地区妇女健康状况不容乐观,应重视弱势人群的健康状况,加强健康教育,定期对妇女进行妇科病普查,有利于早发现、早诊断、早治疗。     

药房托管的试行与发展

近年来我国居民＂看病难、看病贵＂的矛盾不断突出,党和政府以及广大人民群众十分关心,社会各界对此反映十分强烈。医药分开一直是我国医疗卫生体制改革的重点,医院门诊药房托管作为我国医药分开改革中的一种试点模式,在我国已有6年的试行历史,并取得了不俗的成绩。实行药房托管是现行医药体制下的必然选择。本文归纳介绍了药房托管的起源,一般形式及优点,以及完善药房托管的管理措施等,对医院药房的改革有参考作用。医院在进行药房托管试验模式的同时应该抓住机遇,不断提高医院药学专业人员的综合素质,加快医院业务的开展,进一步不断深化医药卫生体制改革。